Tag Archives: PITO

Since the start of the new year I have heard about significant management changes at a number of Canadian EMR vendors. The most recent such change is the departure of Healthscreen’s CEO, Justin Belobaba. According to a media release dated March 4th, 2011, Mr. Belobaba has been replaced by Mr. Stewart Davis, Healthscreen’s Chief Operating Officer.

Although few details regarding the reasons for these management changes are publicly available, there are rumours that financial pressures and poor sales results are a contributing factors. As the industry exhausts the early adopter and early mainstream physicians, are they encountering increased difficulties selling their solutions to the more skeptical and demanding late mainstream and laggard physicians? Were provincial government forecasts for physician adoption of EMRs overly optimistic?

At the end of August I published a blog post entitled “Meaningful Engagement” in which I explored lessons that might be learned from the US process for defining “meaningful use”. In that blog post I reference an article entitled “Certification of Primary Care Electronic Health Records: Lessons Learned from Canada” written by Dr. Mark Dermer and Dr. Matthew Morgan. Although the article offers insights on the engagement process that led to the definition of meaningful use, its primary purpose is to explore the Canadian EMR certification process. In their assessment of Canadian EMR programs, Drs. Dermer and Morgan assert that “the significant variation in which products are chosen in competitions that use very similar specifications (derived from Infoway’s POSR) calls into question the process by which products are evaluated“. To further illustrate the points made in the article, I analyzed data that I have collected on the Canadian EMR market and offer the following observations for consideration:

According to Dr. Alan Brookstone from CanadianEMR, there are approximately 35 vendors offering some form of EMR solution to Canadian physicians.

Nearly all of the 35 EMR vendors are Canadian companies.

Sixteen or slightly less than half of these vendors have products that have been certified by one or more of the six provincial EMR programs (BC, AB, SK, MB, ON, and NS).

None of the sixteen certified vendors has products which are certified by all six provincial EMR programs.

Only one vendor has product which has been certified by four of the six provincial programs.

The majority (62%) of the 16 vendors whose products have been certified by a provincial program have only been certified by a single program.

KLAS surveys end users to determine what they like and don’t like about IT systems that they have purchased. These surveys offer unique insights as they are based on actual use of healthcare IT systems in real world settings. According to Modern Healthcare article, the latest KLAS survey “shows a deterioration of customer-satisfaction scores across the board compared with the survey from the prior year“. Of potential concern to government sponsored funding programs are the results for ambulatory EHRs (referred to as EMRs in Canada). This category had the lowest average satisfaction score of the 24 software categories covered by the KLAS survey.

KLAS President, Adam Gale, offers several explanations:

“That could mean that vendors are selling more and unable to fully staff the uptake.”

“The more enthusiastic and tolerant earlier adopters have already acquired and are already using EHRs. Users new to the technology are adopting now.”

Both explanations are distressing, though the suggestion that mainstream physicians may not be happy with existing EMR products could seriously impact the aggressive targets for EMR use and adoption set by various EMR funding programs.

Is EMR software ready for those physicians who are not early adopters of technology? As Dr. Alan Brookstone notes on his blog:

there are other signs in the US that physicians do not feel that EMR software offers sufficient value to warrant the necessary investments. I think that we must heed these early warning signs and take a closer look at how best to integrate IT into the clinical practice of family physicians so that our current round of funding is not seen as “wasted” in a future auditors report.

This article references a study funded the B.C. Physician Information Technology Office (PITO). This study found that “although the majority of users described a successful EMR implementation, optimal use of EMR functions that would be expected to produce evidence-based benefits and practice quality improvement were not seen in this study. There was no correlation of increasing optimal EMR use with the length of time since implementation.” This observation is particular concerning given the author’s statement that “there is ample evidence showing meaningful returns on investment for doctors once they, as the saying goes, take it to the next level”.

So, the obvious question, what does it take for physicians to take EMRs “to the next level”?